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Subcortical infarction in children
F C Powell1, W C Hanigan, K W McCluney
1Department of Neurological Surgery, University of Illinois College of Medicine at Peoria.
Insights
Pediatric subcortical infarction, though uncommon, often presents as acute hemiparesis in children. Identified risk factors are common, and most children experience good neurological recovery.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroradiology
Background:
- Subcortical infarction is an uncommon neurological event in childhood.
- This study reviews clinical characteristics and outcomes of pediatric subcortical infarction.
- Literature review identifies risk factors and prognoses in affected children.
Observation:
- Five pediatric cases of subcortical infarction were analyzed, with a mean age of 4.8 years.
- Presentations included hemiparesis, dystonia, fever, and focal seizures.
- Identified risk factors included Protein C deficiency and cardiomyopathy.
Findings:
- Literature review of 79 patients revealed common risk factors like infection, trauma, and hematologic disorders.
- Hemiplegia was the most frequent presentation (46/51 patients).
- Approximately 80% of patients showed good or complete resolution of neurological deficits after follow-up.
Implications:
- Subcortical infarction in children typically presents with hemiparesis.
- Early identification of risk factors is crucial for management.
- Prognosis is generally favorable with appropriate care and follow-up.
Background And Purpose:
This report examines the occurrence of subcortical infarction in 5 children, reviews the English literature, and discusses evaluation of this uncommon childhood illness.
Methods:
Clinical characteristics and neurological follow-up were examined in children who presented with subcortical infarction within the past 7 years. The English literature over the previous 20 years was reviewed to identify similar patients with radiological documentation of subcortical infarction.
Results:
Mean age of the patients in this series was 4.8 years (range, 4 months to 12 years); 3 children were female. Three patients presented with the sudden onset of hemiparesis, 1 with dystonia, and 1 with fever and focal seizures. Protein C deficiencies were demonstrated in 2 children; a cardiomyopathy was seen in 1 patient. Mean follow-up was 1.5 years. Two patients were neurologically normal, mild residual symptoms persisted in 2, and 1 patient showed severe dystonia. The literature analysis indicated that specific risk factors were described in 79 patients; complete clinical analysis was available for 51 patients. In the latter group, the mean age was 5.7 years; 26 children were female. Forty-six presented with hemiplegia, 4 with dystonia, and 1 with focal seizures. Follow-up greater than 5 months in 29 patients showed complete or good resolution of deficits in 23. Specific risk factors such as infection, trauma, hematologic disorders, or cardiac or vascular abnormalities were identified in 62 of 79 children.
Conclusions:
This analysis indicates that children with subcortical infarction usually presented with acute hemiparesis. Risk factors were identified in the majority of children, and follow-up demonstrated good or complete resolution of neurological deficits in 80% of the patients.